Radiology/Nuclear Medicine 5.0
HL7 Setup/Implementation Manual
Version 4.0

July 2000

Revised for
Patch RA*5.0*144

March 2018

Department of Veterans Affairs
Health Systems Design and Development
Provider Systems

Revision History

Date / Version / Change / Page
2000 / 1.0 / Initial version of this document
February 2007 / 2.0 / Fully updated to include current functionality
Document reformatted to meet current Documentation Standards
May 2009 / 3.0 / For Patch RA*5*78:
  • Added Legacy to the heading
  • Added Legacy to the heading
  • Added Legacy to the heading
  • Added a section for TCP/IP Optimized HL7 Interfaces
  • Refer to the HL7 Message Specifications document for more information on the structure of these v2.3 HL7 query and response messages
  • Assuming that patch HL*1.6*139 is released when RA*5.0*78 is released. Naturally, the VistA Health Level Sevenapplication should be fully patched
  • Points 2 and 3 reference the double-headed arrow in the diagram
  • Specific IP Port numbers for NTP: 21999 as the required TCP/IP PORT field value and 21998 as the required TCP/IP PORT (OPTIMIZED) field value
  • Body means that all HL7 segments are stored, except the MSH (Message Header) segment
  • Header means that the only HL7 segment stored, is the MSH (Message Header) segment
/ 3
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23
93
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94
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98
August 2011 / 4.0 / Patch RA*5*47
  • Added the name of the updated HL7 Specification for v2.4
  • Added an example message for HL7 v2.4
  • Added an example message for HL7 v2.4, single procedure
  • Added an example message for HL7 v2.4, printset
  • Added an example message for HL7 v2.4, ACK
  • Removed the original 20. TalkStation users are not allowed to group sets of exams together and mark them for a single report….
  • Removed the original 19. PowerScribe users are not allowed to group sets of exams together and mark them for a single report….
  • Added a section about the HL7 messaging version 2.4: Setup Instructions/Examples for using IHE compliant HL7 v2.4 Protocols
  • Updated three v2.4 message examples
/ 3
7
9
10
11
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64
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March 2018 / 5.0 / Patch RA*5*144
Remove patch 78 Query documentation
Release Study (NTP) / 93
1, 5, 85

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Table of Contents

Introduction

Rad/Nuc Med Legacy HL7 Interface Specifications

Discussion of Vendor-Initiated Messages

Sample Clinical Scenario for Vendor-Initiated Messaging

Messaging Specifics for Vendor-Initiated Messages

Discussion of Rad/Nuc Med-Initiated Messages

Clinical Scenarios for Rad/Nuc Med-Initiated Messages

Registration

Exam Edited

Cancellation/Deletion

Verified/Released Unverified Report

Release Study

Messaging Specifics for Rad/Nuc Med-Initiated Messages

Setup Instructions/Examples for VistA to VistA Same-system, Different Application Messages Initiated by Rad/Nuc Med

Introduction

Requirements

Setup of Legacy HL7 Files for VistA-VistA Radiology Interface

Setup Instructions/Examples for TCP/IP Legacy HL7 Interfaces between Rad/Nuc Med and COTS Products

Introduction

Requirements

Setup of HL7 Files for One-way Radiology to COTS Interface

Setup of HL7 Files for Two-way Radiology/COTS Interface

Message Flow Diagram

Scenario 1 - VA Sends Order or Report Messages to the COTS Product Server

Scenario 2 - Processing Reports from COTS Product Server

Startup and Recovery

One-way TCP/IP Interface

Two-way TCP/IP Interface

VistA HL7 Message Files

Implementing and Maintaining an Interface between Radiology and the TalkStation Voice Reporting Tool

Introduction

Requirements

Operational Features of the Interface

IRM and ADPAC Setup Procedures

Setup of HL7 Files

Detailed Explanation of Start-up/Recovery Procedure

Start-up/Recovery Procedure Quick Reference

Implementing and Maintaining an Interface between Radiology and the PowerScribe Voice Reporting Tool

Introduction

Requirements

Operational Features of the Interface

IRM and ADPAC Set-up Procedures

Setup of HL7 Files

Configuring PowerScribe HL7 Protocol Settings

Detailed Explanation of Start-up/Recovery Procedure

Start-up/Recovery Procedure Quick Reference

VistA Rad/Nuc Med HL7 Error Message and Troubleshooting Table for TalkStation and PowerScribe Interfaces

Setup Instructions/Examples for Using IHE compliant HL7 v2.4 Protocols

Setting Up the Voice Recognition Event Driver Protocols

Step 1 - Remove subscribers from existing ORM event driver protocols

Step 2 - Remove subscribers from existing ORU event driver protocol

Step 3 - Add subscribers to new ORM event driver protocols

Step 5 - Change the Version ID field of existing message receipt protocol to 2.4

Step 6 - Turn on the use of the long site accession number

March 2018Radiology/Nuclear Medicine 5.0 1
HL7 Setup/Implementation Manual

Introduction

The Radiology/Nuclear Medicine (Rad/Nuc Med) package is a comprehensive software package designed to assist with the functions related to processing patients for imaging examinations.

The package automates a range of Rad/Nuc Med functions, including order entry of requests for exams by clinical staff, registration of patients for exams, processing of exams, recording reports/results, and verification of reports. The package interfaces with and through the Health Level Seven (HL7) package to exchange this exam and report information.

HL7 is an ANSI messaging transaction standard for healthcare. It is the main strategy used in a variety of healthcare providers and applications vendors to achieve Enterprise Application Integration (EAI) between disparate clinical applications.

The Rad/Nuc Med package supports the Integrating the Healthcare Enterprise (IHE) initiative. IHE is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care.

Because many vendors support the IHE initiative, it allows Rad/Nuc Med to exchange key datasets with other VistA and Commercial Off-The-Shelf (COTS) products.

Rad/Nuc Medallows report transmission. That is, reports can be transmitted to Rad/Nuc Med from an outside source and filed as if entered in the Rad/Nuc Med package.

Rad/Nuc Med also has the ability to broadcast messages to outside sources. These messages are typically consumed by vendor PACS Systems, VistA Imaging, and VoiceRecognition (VR) dictation systems. Rad/Nuc Med broadcasts messages when exams are registered, edited, cancelled or deleted, and reported or released.

The following chapters describe the information that can be manipulated with the Rad/Nuc Med and HL7 software. It also describes how to set up an HL7 interface to and from Radiology (both TCP/IP and non-TCP), and later describes how to implement/maintain the three VR system interfaces (for PowerScribe,TalkStation, and RadWhere) which have been developed, and are supported by, the Rad/Nuc Med developers.

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Rad/Nuc MedLegacy[1]HL7 Interface Specifications

For a description of the HL7 messages shared between the Rad/Nuc Medapplicationand those commercial off the shelf (COTS) applications subscribing to theRad/Nuc Med application, refer to the

  • Radiology/Nuclear Medicine Health Level Seven (HL7) Interface Specifications for Voice Recognition Dictation Systems – HL7 version 2.3
  • Radiology/Nuclear Medicine 5.0 HL7 Interface Specification – HL7 version 2.4[2]

Discussion of Vendor-Initiated Messages

Vendor systems or other applicationsmay send report (ORU) results for a selected exam back to the Rad/Nuc Med package. The report will be acknowledged (ACK) either positively or negatively with an error message. If the case selected is one of a "printset" (e.g., same report should apply to multiple cases) the Rad/Nuc Med software will detect this when the report message is received and will use the report for all cases in the set.

Sample Clinical Scenario for Vendor-Initiated Messaging

A patient is registered within the VistA Rad/Nuc Med system for an exam. The imaging exam is performed and the images for the case are given to a radiologist or nuclear medicine physician. The physician uses the vendor equipment to enter findings in a report and performs whatever action is necessary to trigger the vendor software to create and send to VistA an HL7 ORU message containing the report. VistA accepts and files the report and sends a positive acknowledgment (ACK) message, or rejects the report and sends an HL7 response (ACK) indicating why it was rejected.

Messaging Specifics for Vendor-Initiated Messages

When the vendor (or other) application sends report results, they send an Observational Results Unsolicited (ORU) message to the Rad/Nuc Med package. The ORU message consists of the following segments:

  • MSHMessage Header
  • PID Patient Identification
  • OBRObservational Request
  • OBXResult

Example for HL7 v2.3

MSH^~|\&^RA-SERVER-IMG^HINES CIOFO^MAGD-CLIENT^884

^20050426130221-0600^^ORU~R01^499539643619^P^2.3.1^^^^^US

PID^^00-22-4444~~^121~4~M10^^REALLYLONGSURNAMEXXXX~

MISSXXXX^^19730414^F^^^^^^^^^^^000224444

OBR^^^6958798.8966-1~120104-1732~L^76090~MAMMOGRAM, ONE BREAST~C4~435~MAMMOGRAM UNILAT~99RAP^^^200412011033-0600^""^""^^^^^20050426130124-0600^^0123~ STAFF~FIRST~M

^^MAMMOGRAM TEST CASE I^^23~MAMMOGRAPHY LAB~499~SUPPORT ISC^^2005042613020600^^^F^^^^^^^0123~STAFF~FIRST~M ^0456~RESIDENT~FIRST^^0123~STAFF~FIRST~M^200412011033-0600

OBX^^CE^P~PROCEDURE~L^^435~MAMMOGRAM UNILAT~L^^^^^^F

OBX^^TX^I~IMPRESSION~L^^impression txt checking the HL7 messaged format for verified (ORU) messages. ^^^^^^F

OBX^^CE^D~DIAGNOSTIC CODE~L^^1~NORMAL~L^^^^^^F

OBX^^TX^R~REPORT~L^^report text checking the HL7 messaged format for verified (ORU) messages. ^^^^^^F

OBX^^TX^M~MODIFIERS~L^^RIGHT^^^^^^F

OBX^^TX^TCM~TECH COMMENT~L^^testing the VR interface with WH

MAMMOGRAM UNILAT (MAM Detailed) CPT:76090^^^^^^F

Notes:The Diagnostic Code sent to VistA must be one of a predefined set in the VistA Rad/Nuc Med's Diagnostic Codes file (#78.3). These codes are facility specific. Impression is mandatory when ‘Impression required on Reports’ (field .116) is set for the Division (file #79).
The Rad/Nuc Med package sends back a General Acknowledgment (ACK) message. If the report is rejected, possible reasons are invalid or duplicate diagnostic code, provider not classified as "staff" or "resident" within the Rad/Nuc Med package, missing or invalid patient identification, an attempt was made to edit a canceled case, or a case where a report is already on file, missing impression text, or missing segment or field from a message.

Discussion of Rad/Nuc Med-Initiated Messages

The Rad/Nuc Med package will send an HL7 message with exam information to all site specified subscribers, if one or more is defined within the VistA Health Level Seven package setup, when each exam has been registered, examined (i.e., images have been collected), canceled, and when a report has been put in a status of Verified or Released/Not Verified. Subscribers may choose to subscribe to a subset rather than all of the available messages. Later sections show examples of VistA file setup that is necessary to accomplish this.

Clinical Scenarios for Rad/Nuc Med-Initiated Messages

Registration

A VAMC may register a patient for an imaging exam at the time the patient arrives at the radiology or nuclear medicine reception desk for his/her appointment, or registration may be done up to a week prior to the appointment depending on the policy of that VAMC's imaging services. At this point, the registration message is broadcast and can be sent as an "order" to the PACS/Imaging, Voice Recognition,or other recipients. For exam sets, each procedure will be sent in its own HL7 message.

Exam Edited

Anytime the exam is edited, either through edit or status tracking, an ‘examined’ message will be broadcast. In the past, the VistA Rad/Nuc Med software allowed the ADPAC to specify an exam status that will trigger this event. Unfortunately, exam specific data could be edited without moving to a status that triggers an examined message. If, for example, the "Examined" status is specified, when the radiology tech enters the required data to cause the exam record to reach the "Examined" status, the examined message will be broadcast. This message is intended to signal the recipient that images have been collected. This is especially useful for interfacing with PACS equipment if the VAMC is running the VistA Imaging/Multi-Media software, which will then expect a message containing image ID's back from the PACS equipment. The Imaging/Multi-Media software then files the image ID's with the Rad/Nuc Med report through an Imaging-Rad/Nuc Med interface.

Cancellation/Deletion

If an imaging tech or other VistA Rad/Nuc Med software user cancels or deletes an exam, this will trigger the cancel message broadcast. An exam is usually canceled before it is done. However, since exam data may have been erroneously entered, or entered for the wrong patient, the VistA Rad/Nuc Med system allows users to back data out and cancel after an exam is done, and possibly after results reports are entered. So, there is a possibility that anexamined message and a report message would have been broadcast prior to a cancellation message.

Verified/Released Unverified Report

The report message is triggered when a VistA Rad/Nuc Med radiologist or transcriptionist enters data causing the findings report to move to a "Verified" (final) or "Released/Unverified" (preliminary) status. Depending on the policy of the VAMC, the "Released/Unverified" status may or may not be allowed. If the released/unverified report is broadcast on a message, a later message will contain the verified (final) report. It is also possible for a verified report to be retracted ("Unverified"), then re-verified later. If this happens a second report message would be broadcast with the amended, re-verified report, or else an exam cancel/delete message would be broadcast retracting the entire exam.

The registration message will always be the first message generated since registration must be done before any of the other events can take place. There is no software setup that can prevent users from entering and verifying a report prior to the tech entering exam information, so there is no guarantee that the "Examined" message will be sent before the "Report" message. However, a facility can choose to enforce the practice of case editing before entering and verifying reports toguarantee that the case gets to the proper "Examined" status before the report is verified.

Release Study

The v2.4 report message is triggered when National Teleradiology (NTP) releases a study back to the local facility for interpretation. This ‘Release Study’ message will always follow a NTP ‘Released/Unverified (preliminary)’ message.

Messaging Specifics for Rad/Nuc Med-Initiated Messages

When an exam is registered, examined or cancelled by the Rad/Nuc Med package, an Order (ORM) message is sent to the site-specified application. The ORM message consists of the following segments:

  • MSHMessage Header
  • PID Patient Identification
  • ORCCommon Order
  • OBRObservational Request
  • OBXResult
  • ZDSStudy Instance UID

Example for HL7 v2.3

MSH^~|\&^RA-SERVER-IMG^HINES CIOFO^MAGD-CLIENT^884^20050331082734-0600^^ORM~O01^499539642582^P^2.3.1^^^^^US

PID^^^666000000~~~USSSA&0363~SS~VA FACILITY ID&L|00~~~USVHA&0363~PI~VA FACILITY ID&L^^RADPATIENT~FIRST~I~~~~L^^19450000^M^^""^111 NOWHERE~PO BOX ALLEY~CHICAGO~IL~60612~~P~""|~~""~""~~~N^^""^""^^^^^666000000^^^""^^^^^

^^^^

PV1^^I^7AS~200~RADLOCATION^^^^0000~RADTECH~FIRSTNAME~I^^^7AS^^^^^A2^^^^2729

ORC^NW^033105-1821^0331051821^^IP^^~~~~~R^^200503310819480600^

0000~RADSTAFF~FIRSTNAME~I ^^0000~RADSTAFF~FIRSTNAME~I^INFORMATION RESOURCE MGMT^786-5904~WPN~PH^^^IRM~INFORMATION RESOURCE MGMT~VistA49

OBR^1^033105-1821^033105-1821^73020~X-RAY EXAM OF SHOULDER~C4~123~SHOULDER 1

VIEW~99RAP^R^^^^^^^^^^~~~~&left^0000~RADSTAFF~FIRSTNAME~I^000-0000~WPN~PH^6949668.9189-1^033105-1821^4~X-RAY CLINIC COUNT~499~SUPPORT ISC^RAD~GENERAL RADIOLOGY^^^^^^~~~~~R^^^WHLC^See History

ZDS^*** TESTING, THIS NODE IS A THROWAWAY ***.1.4.6025.6949668.9189.1.033105.1821

~VistA~Application~DICOM

OBX^^CE^P~PROCEDURE~L^^SHOULDER 1 VIEW^^^^^^O

OBX^1^TX^M~MODIFIERS~L^^LEFT^^^^^^O

OBX^1^TX^H~HISTORY~L^^test clinical history/reason for version 2.3.1 HL7 messages ^^^^^^O

OBX^1^TX^A~ALLERGIES~L^^PENICILLIN(V)^^^^^^O

OBX^2^TX^A~ALLERGIES~L^^TETRACYCLINE(V)^^^^^^O

OBX^3^TX^A~ALLERGIES~L^^ERYTHROMYCIN(V)^^^^^^O

OBX^4^TX^A~ALLERGIES~L^^AMIODARONE(N)^^^^^^O

OBX^5^TX^A~ALLERGIES~L^^ESTRADIOL CYPIONATE(V)^^^^^^O

OBX^6^TX^A~ALLERGIES~L^^ASPIRIN(V)^^^^^^O

OBX^7^TX^A~ALLERGIES~L^^FORTAZ ADD-VANTAGE(V)^^^^^^O

OBX^8^TX^A~ALLERGIES~L^^CODEINE(N)^^^^^^O

OBX^9^TX^A~ALLERGIES~L^^RADIOLOGICAL/CONTRAST MEDIA(V)^^^^^^O

OBX^1^TX^TCM~TECH COMMENT~L^^sample technologist comments for display purposes only^^^^^^O

Example for HL7 v2.4[3]

MSH|^~\&|RA-VOICE-SERVER|HINES CIOFO|RA-TALKLINK-TCP|TalkStation|20110629092627-

0500||ORM^O01|4993885697|P|2.4|||||USA

PID||141-167^^^USVHA^PI|666432134^^^USVHA^NI|6666559019V812454^^^USVHA^NI|INPATI

ENT^VISIT||19350101|M||""^^0005^""^^CDC|""^""^""^""^""||||||||666432134|||""^^01

89^""^^CDC

PV1||I|4AS-1^410^1||||28^RAD^PROVIDER1|28^RAD^PROVIDER1||CARDIOLOGY|||||A2||28^RAD

^PROVIDER1||I2189|||||||||||||||||||||||||20070119094640-0500

ORC|NW|141-062911-3432|141-062911-3432||IP||^^^^^R||201106290920-0500|1901^RADIOLOGY

^USER1||1901^RADIOLOGY^USER1|INFORMATION RESOURCE MGMT|123-456-7890^PRN^PH~098-7

65-4321^WPN^PH~543-543-5435^^PH|||IRM^INFORMATION RESOURCE MGMT^VISTA49

OBR|1|141-062911-3432|141-062911-3432|73562^X-RAY EXAM OF KNEE 3^C4^155^KNEE 3 VIEWS

^99RAP|R||||||||||^^^^&right|1901^RADIOLOGY^USER1|123-456-7890^PRN^PH~098-765-4321

^WPN^PH~543-543-5435^^PH|141-062911-3432|3432|141-062911-3432|RAD_GENERAL RADIOLO

GY`3_RADIOLOGY LAB`499_SUPPORT ISC||||||^^^^^R|||WHLC|^Pain in right knee when

walking.

ZDS|1.2.840.113754.1.4.141.6889370.9079.1.141.62911.3432^VISTA^Application^DICOM

OBX|1|CE|P^PROCEDURE^L||155^KNEE 3 VIEWS^L||||||O

OBX|2|TX|M^MODIFIERS^L||RIGHT||||||O

OBX|3|CE|C4^CPT MODIFIERS^L||26^PROFESSIONAL COMPONENT^C4||||||O

OBX|4|CE|C4^CPT MODIFIERS^L||LT^LEFT SIDE^C4||||||O

OBX|5|TX|H^HISTORY^L||Reason for Study: Pain in right knee when walking.||||||O

OBX|6|TX|H^HISTORY^L|| ||||||O

OBX|7|TX|H^HISTORY^L||Clinical history text entered here for this sample case us

ing the v2.4 HL7||||||O

OBX|8|TX|H^HISTORY^L||interface. ||||||O

OBX|9|TX|A^ALLERGIES^L||APRICOTS(V)||||||O

OBX|10|TX|A^ALLERGIES^L||KIWI FRUIT(V)||||||O

OBX|11|TX|TCM^TECH COMMENT^L||The tech comment is that this is case #3432.||||||O

Note: The messages broadcast at these three event points (registered, examined and cancelled) are almost identical, with the exception of the Order Control, Order Status, and Mode of Transportation. Differences to note between an HL7 message for registration, image collection (examined) and cancellation are shown.

HL7 ORC Field / Registration / Cancel/Delete / Examined
1-Order Contro / NW / CA / XO
5-Order Status / IP / CA / CM

The Mode of Transportation value on the OBR segment (in the example above, ~R) is omitted from the cancellation message.